Time Of Total Hip Replacement Research Articles

Excision of trochanteric bursa during total hip replacement: Does it reduce the incidence of post-operative trochanteric bursitis?

Trochanteric bursitis is a common complication following total hip replacement (THR), and it is associated with high level of disability and poor quality of life. Excision of the trochanteric bursa prophylactically during THR could reduce the occurrence of post-operative trochanteric bursitis. To evaluate whether synchronous trochanteric bursectomy at the time of THR affects the incidence of post-operative trochanteric bursitis. This retrospective cohort study was conducted in the secondary care setting at a large district general hospital. Between January 2010 and December 2020, 954 patients underwent elective primary THR by two contemporary arthroplasty surgeons, one excising the bursa and the other not (at the time of THR). All patients received the same post-operative rehabilitation and were followed up for 1 year. We reviewed all cases of trochanteric bursitis over this 11-year period to determine the incidence of post-THR bursitis. Two proportion Z-test was used to compare incidences of trochanteric bursitis between groups. 554 patients underwent synchronous trochanteric bursectomy at the time of THR whereas 400 patients did not. A total of 5 patients (incidence 0.5%) developed trochanteric bursitis following THR; 4 of whom had undergone bursectomy as part of their surgical approach, 1 who had not. There was no statistically significant difference between the two groups (Z value 1.00, 95%CI: -0.4% to 1.3%, P = 0.32). There were also 8 other patients who had both trochanteric bursitis and hip osteoarthritis prior to their THR; all of whom were treated with THR and synchronous trochanteric bursectomy, and 7 had resolution of their lateral buttock pains but 1 did not. Synchronous trochanteric bursectomy during THR does not materially affect the incidence of post-operative bursitis. However, it is successful at treating patients with known trochanteric bursitis and osteoarthritis requiring THR.

Increased one-year risk of symptomatic venous thromboembolism following total hip replacement

We examined the one-year risk of symptomatic venous thromboembolism (VTE) following primary total hip replacement (THR) among Danish patients and a comparison cohort from the general population. From the Danish Hip Arthroplasty Registry we identified all primary THRs performed in Denmark between 1995 and 2010 (n = 85965). In all, 97% of patients undergoing THR received low-molecular-weight heparin products during hospitalisation. Through the Danish Civil Registration System we sampled a comparison cohort who had not undergone THR from the general population (n = 257895). Among the patients undergoing THR, the risk of symptomatic VTE was 0.79% between 0 and 90 days after surgery and 0.29% between 91 and 365 days after surgery. In the comparison cohort the corresponding risks were 0.05% and 0.12%, respectively. The adjusted relative risks of symptomatic VTE among patients undergoing THR were 15.84 (95% confidence interval (CI) 13.12 to 19.12) during the first 90 days after surgery and 2.41 (95% CI 2.04 to 2.85) during 91 to 365 days after surgery, compared with the comparison cohort. The relative risk of VTE was elevated irrespective of the gender, age and level of comorbidity at the time of THR. We concluded that THR was associated with an increased risk of symptomatic VTE up to one year after surgery compared with the general population, although the absolute risk is small.

Chondrogenic Potential of Human Adult Mesenchymal Stem Cells Is Independent of Age or Osteoarthritis Etiology

Osteoarthritis (OA) is a multifactorial disease strongly correlated with history of joint trauma, joint dysplasia, and advanced age. Mesenchymal stem cells (MSCs) are promising cells for biological cartilage regeneration. Conflicting data have been published concerning the availability of MSCs from the iliac crest, depending on age and overall physical fitness. Here, we analyzed whether the availability and chondrogenic differentiation capacity of MSCs isolated from the femoral shaft as an alternative source is age- or OA etiology-dependent. MSCs were isolated from the bone marrow (BM) of 98 patients, categorized into three OA-etiology groups (age-related, joint trauma, joint dysplasia) at the time of total hip replacement. All BM samples were characterized for cell yield, proliferation capacity, and phenotype. Chondrogenic differentiation was studied using micromass culture and analyzed by histology, immunohistochemistry, and quantitative reverse transcriptase-polymerase chain reaction. Significant volumes of viable BM (up to 25 ml) could be harvested from the femoral shaft without observing donor-site morbidity, typically containing >10(7) mononuclear cells per milliliter. No correlation of age or OA etiology with the number of mononuclear cells in BM, MSC yield, or cell size was found. Proliferative capacity and cellular spectrum of the harvested cells were independent of age and cause of OA. From all tested donors, MSCs could be differentiated into the chondrogenic lineage. We conclude that, irrespective of age and OA etiology, sufficient numbers of MSCs can be isolated and that these cells possess an adequate chondrogenic differentiation potential. Therefore, a therapeutic application of MSCs for cartilage regeneration of OA lesions seems feasible. Disclosure of potential conflicts of interest is found at the end of this article.

Horizontal platform supported hip replacement.

The cementless horizontal platform supported femoral component for hip replacement was designed to provide physiologic stress loading of the proximal femur after hip replacement. The goal is to extend pain-free implant survival by reducing periprosthetic bone resorption and to provide improved hip function and many years of relief from hip pain. A total hip replacement using this prosthesis was done in 334 consecutive nonselective hips in 322 patients. The mean age of the patients at the time of total hip replacement was 69 years (range, 29-89 years). Thirty-two patients (34 hips) were lost to followup and 81 patients (83 hips) died less than 10 years postoperatively. The remaining 209 patients (217 hips) were followed up for a minimum of 10 years (maximum, 14 years). There were six revisions of the femoral prosthesis. Three (1.8%) were revised for loosening, two were revised for femoral fracture, and one was revised for unexplained pain. The rate of stem survival was 0.97 +/- 0.02 (mean and standard error). There were 209 (96%) hips with excellent or good results. Seven (3%) patients had osteolytic changes develop. Radiographic evidence of diminished bone density in the proximal femur was seen in 34 hips (16%). The clinical results are comparable with other reported results for cementless hip replacements at 10 years.

Fixation and effect on bone strain pattern of a stemless hip prosthesis

Given the relatively short survival time of total hip replacement in young patients, a different concept of femoral implant was designed and evaluated biomechanically prior to clinical application. The femoral component has no intramedullary stem and fits into an angular resection of the femoral neck. A trans-trochanteric screw provides immediate strong fixation. A comparative biomechanical study with cadaver femora and a dynamic hip simulator was performed. The study had three objectives. (1) The strains generated under loading in the intact proximal femur were compared to those generated in the presence of the experimental implant and a classic cemented implant. (2) The short-term stability of the experimental prosthesis under loading conditions encountered during fast walking was evaluated. (3) Most importantly, the implant design was improved in the light of the experimental observations prior to any clinical trial. Indeed, the prototype underwent several important modifications in the course of the study. With the modified design, later used in a clinical trial, it was demonstrated that if accurate fit and position of the prosthesis were provided, fixation remained sound for over one million loading cycles with peak loads of three times the body weight. The measured interface micromotion was compatible with direct bone apposition and ingrowth. No statistical difference was found between the strain measurements obtained before and after implantation of the experimental prosthesis whereas significant stress shielding was observed with a stemmed, cemented prosthesis.

The painful migrated ununited greater trochanter in total hip replacement

The migrated painful ununited trochanter following total hip replacement can provoke a significant degree of functional disability. Although this condition is infrequently observed after total hip replacement, its occurrence causes definite problems for its operative management. A technique employing the trochanteric bolt for reattachment of the migrated painful trochanteric fragment is described. The results of this approach in five patients to date are relief from pain and decreased disability in all five. The factors promoting migration of the osteotomized fragment include the quality of the trochanteric bone, the stresses placed on the osteotomy site by the patient during the postoperative period, and the precise method of reattachment of the trochanter at the time of total hip replacement.

Biochemical and metabolic characteristics of articular cartilage from osteonecrotic human femoral heads

The cartilage from nine osteonecrotic femoral heads (six post-traumatic and three corticoid-induced) was obtained at the time of total hip replacement and studied by biochemical and metabolic techniques. The data obtained were compared with those previously obtained in normal hips and were correlated with diagnosis, topographical site, histology, and grading according to a histological-histochemical technique previously described. The results demonstrated surprisingly good preservation of cartilage and no significant alteration in the biochemical and metabolic parameters. These findings showed limited correlation with the topographical site and no correlation with the cause of the necrosis or histological alteration. The results do not support concepts of either accelerated metabolic activity or chondrolytic change.

The ‘tilt deformity’ of the femoral head in osteoarthritis of the hip: A poor indicator of previous epiphysiolysis

Apparent superomedial migration of the femoral head producing the 'tilt deformity' is the most frequent pattern of femoral head deformity in osteoarthritis of the hip. Previous reports have suggested a relationship to minor degrees of epiphysiolysis in the adolescent. Radiological and pathological examination of femoral heads obtained at the time of total hip replacement for osteoarthritis demonstrate characteristic abnormalities accompanying the 'tilt deformity'. It would appear that, in most patients, this pattern of femoral head migration results not from epiphysiolysis but from a remodelling process in the osteoarthritic joint.

Antibiotics in human hematoma and wound fluid.

Using the total hip replacement patient, we measured the level of antibiotic in the wound at the time of surgery, the wound drainage for 36 to 48 hours after surgery and over a 10 day period in incubated surgical debris obtained at the time of total hip replacement. The antibiotics sodium oxacillin, lincomycin hydrochloride and sodium cephalothin were administered in standard doses at 6 hour intervals. In one group of patients the antibiotic was begun at the time of surgery, in a second group the antibiotic was begun 24 hours after the completion of surgery. Sodium oxacillin, lincomycin hydrochloride and sodium cephalothin produce antibiotic levels in the venous serum consistently above the level obtained in the simultaneous would drainage specimens. Sodium oxacillin and lincomycin hydrochloride used as described in this study are capable of bathing the area of the surgical wound with concentrations of antibiotics above the minimal inhibitory concentrations. This is evidenced by the antibiotic levels above minimal inhibitory concentrations found in the wound drainage. Sodium cephalothin levels in the wound drainage were below measurable levels in 3 of 4 patients. Sodium oxacillin and lincomycin hydrochloride antibiotic levels in the surgical wound debris and simultaneous venous clotted specimens diminished progressively in a similiar manner indicating no additional effects of the surgical wound debris on the antibiotic's biologic effectiveness. Sodium cephalothin dropped below measurable levels in three days. Measurable levels of antibiotics appeared in the wound aspirate well above the minimal inhibitory concentration in patients receiving their initial dose of sodium oxacillin 24 hours after surgery.